Designing Inter- and Transdisciplinary Research on Mountains: What Place for the Unexpected?

In recent decades, research on mountains has become more inter- and transdisciplinary, but a greater effort is needed if such research is to contribute to a societal transformation toward sustainability. Mountain research centers are a crucial actor in this endeavor. Yet, the literature has not paid sufficient attention to how these centers should (re-)design inter- and transdisciplinary research. In this study, we explored this question with a self-reflexive approach. We analyzed the first 15 months of the Interdisciplinary Centre for Mountain Research (CIRM) of the University of Lausanne (Switzerland) through qualitative data collected via interviews and observation. We used a simple model of inter- and transdisciplinarity at the organizational level of a research center. Special attention was devoted to the individual and collective ability to exploit the unexpected (serendipity). Our results indicate an interdependency between the coconstruction of research objects and the creation of integrative partnerships. They also shed light on the types of institutional resources and integrative methodologies that enhance inter- and transdisciplinary research, as well as their challenges. Our experience shows that implementing inter- and transdisciplinarity requires deep changes in research evaluation procedures, research funding policies, and researchers themselves. Serendipity is in turn shown to play an important role in inter- and transdisciplinarity due to its potential to change the research process in creative ways. We speculate that serendipity offers unique opportunities to capitalize on hidden resources that can catalyze a radical transformation of mountain researchers, research organizations, and society in the face of unprecedented global change

Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series

BACKGROUND: Opportunistic invasive fungal infections are increasingly frequent in intensive care patients. Their clinical spectrum goes beyond the patients with malignancies, and for example invasive pulmonary aspergillosis has recently been described in critically ill patients without such condition. Liver failure has been suspected to be a risk factor for aspergillosis. CASE PRESENTATION: We describe three cases of adult respiratory distress syndrome with sepsis, shock and multiple organ failure in patients with severe liver failure among whom two had positive Aspergillus antigenemia and one had a positive Aspergillus serology. In all cases bronchoalveolar lavage fluid was positive for Aspergillus fumigatus. Outcome was fatal in all cases despite treatment with voriconazole and agressive symptomatic treatment. CONCLUSION: Invasive aspergillosis should be among rapidly raised hypothesis in cirrhotic patients developing acute respiratory symptoms and alveolar opacities

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Description, évolution et facteurs pronostiques des infections pulmonaires à pneumocystis jirovecii en réanimation (comparaison selon le statut VIH au sein d une cohorte rétrospective)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pneumopathies extra-hospitalières liées aux soins (un concept pertinent ?)

Il est proposé de classer les pneumonies en Pneumonies Aiguës Communautaires (PAC), Pneumonies Extra-Hospitalières Liées aux Soins (PEHLS), Pneumonies Acquises à l Hôpital (PAH) et Pneumonies Acquises sous Ventilation Mécanique (PAVM), afin, notamment, de proposer une antibiothérapie initiale mieux adaptée. Cependant les données concernant les PEHLS et les PAH sont peu nombreuses, notamment en France. Il s agit d une étude épidémiologique, rétrospective, monocentrique. Nous avons recueilli les données épidémiologiques, cliniques, biologiques, microbiologiques, et thérapeutiques de toutes les pneumopathies infectieuses admises dans notre unité de Réanimation entre janvier 2006 et avril 2008. Sur les 263 patients inclus, 86 avaient une PAC (33%), 57 une PEHLS (21%), 89 une PAH (34%) et 31 une PAVM (12%). La gravité à l admission de ces différentes pneumonies était identique selon l Index de Gravité Simplifié (IGS2), ainsi que le taux de mortalité. Lors des PEHLS, les prélèvements ont mis en évidence 35,1% de bactéries communautaires et 28,8% de bactéries hospitalières . Aucune documentation bactériologique n a pu être faite dans 47,4% des cas. Lors des PAH, des germes communautaires ont été mis en évidence dans 18,9% des cas et des germes hospitaliers dans 58,4% des cas. Aucune documentation bactériologique n a pu être faite dans 33,7%. Dans notre expérience, nous ne pouvons pas proposer d utiliser la classification des pneumonies en PEHLS, concept trop hétérogène, ne permettant pas à lui seul de proposer une attitude thérapeutique adéquate.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

LES EMBOLIES PULMONAIRES FIBRINO CRUORIQUES AU C.H. DE SABLE SUR SARTHE DE 1990 A 1998 (EXCLUES LES EMBOLIES PULMONAIRES POST-CHIRURGICALES ET DE LA GROSSESSE)

ANGERS-BU Médecine-Pharmacie (490072105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

VARIABILITE TEMPORELLE DE LA VENTILATION CHEZ DES PATIENTS DE REANIMATION LORS DU SEVRAGE DE LA VENTILATION MECANIQUE

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Safety of performing fiberoptic bronchoscopy in critically ill hypoxemic patients with acute respiratory failure.: Bronchoscopy in Hypoxemic Patients

International audienceBACKGROUND: The safety of fiberoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure has not been extensively evaluated. We aimed to measure the incidence of intubation and the need to increase ventilatory support following FOB and to identify predictive factors for this event. METHODS: A prospective multicenter observational study was carried out in eight French adult intensive care units. The study included 169 FOB performed in patients with a PaO(2)/FiO(2) ratio ≤ 300. The main end-point was intubation rate. The secondary end-point was rate of increased ventilatory support defined as an increase in oxygen requirement >50 %, the need to start noninvasive positive pressure ventilation (NI-PPV) or increase NI-PPV support. RESULTS: Within 24 h, an increase in ventilatory support was required following 59 bronchoscopies (35 %), of which 25 (15 %) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD; OR 5.2, 95 % CI 1.6-17.8; p = 0.007) or immunosuppression (OR 5.4, 95 % CI 1.7-17.2; p = 0.004] were significantly associated with the need for intubation in the multivariable analysis. None of the baseline physiological parameters including the PaO(2)/FiO(2) ratio was associated with intubation. CONCLUSIONS: Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD and immunosuppression are associated with the need for invasive ventilation in the 24 h following bronchoscopy